Is The ACGME Resident/Fellow Survey a Valid Tool to Assess General Surgery Residency Programs Compli...
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Robert P. Sticca, MD, FACS Jay M. MacGregor, MD Randolph E. Szlabick, MD, FACS PowerPoint PPT Presentation


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Is The ACGME Resident/Fellow Survey a Valid Tool to Assess General Surgery Residency Programs Compliance with Work Hours Regulations?. Robert P. Sticca, MD, FACS Jay M. MacGregor, MD Randolph E. Szlabick, MD, FACS Department of Surgery University of North Dakota SMHS. Background.

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Robert P. Sticca, MD, FACS Jay M. MacGregor, MD Randolph E. Szlabick, MD, FACS

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Robert p sticca md facs jay m macgregor md randolph e szlabick md facs

Is The ACGME Resident/Fellow Survey a Valid Tool to Assess General Surgery Residency Programs Compliance with Work Hours Regulations?

Robert P. Sticca, MD, FACS

Jay M. MacGregor, MD

Randolph E. Szlabick, MD, FACS

Department of Surgery

University of North Dakota SMHS


Background

Background

  • 2003 – ACGME work hours regulations implemented

  • 2004 – ACGME Residents/Fellows Survey

  • 2008 – Special Message from CEO ACGME (Thomas Nasca, MD)

    • Standard Approach to Programs Across All Specialties with Potential Duty Hours Violations Identified in the Resident Survey


Acgme special message

ACGME Special Message

  • The Monitoring Committee has accepted the Resident Survey as a reliable, sensitive and reasonably specific tool

  • The Monitoring Committee has set reasonable thresholds for categorization of a program as having Potential Duty Hours Violations (PDHV) based on the Resident Survey

  • The validity of the Resident Survey has been demonstrated though significant correlations with site visit findings to warrant added scrutiny for programs meeting the thresholds of potential noncompliance found in the group targeted for follow-up.

  • There is a significant correlation between resident reported violations of duty hours with deficiencies in other important areas of the learning environment(correlation 0.51, p<0.0001)

Nasca, T. www.ACGME.org


Acgme algorithm for noncompliant programs

ACGME Algorithm for Noncompliant Programs

Nasca, T. www.ACGME.org


Und experience

UND Experience

  • 2005 – RRC site visit – additional categorical resident requested

    • 5 year approval, no deficiencies

    • Additional resident denied, insufficient educational justification

  • 2007 – RRC site visit – additional categorical resident requested

    • 5 year approval, no deficiencies

    • Additional resident approved

  • 2009 – RRC site visit – mandatory due to residents responses on survey

    • 5 year approval - commendation


Acgme survey problems

ACGME Survey - Problems

  • Answer selections vague

  • High threshold for compliance

  • Small program effect

  • Consequences of survey punitive

  • Consequences based on survey results and not actual work hours data


Current study

Current Study

  • Purpose – obtain general surgery residents views on work hours regulations and ACGME survey

  • Design – 20 question survey emailed to all Gen. Surg. Program Directors – 5/09

    • 9 questions – work hours

    • 9 questions – ACGME survey

    • 1 both, 1 demographic, comments

  • Study period – 5/09 – 10/09

    • Multiple reminders, pleas for participation

  • Internet Survey – surveymonkey.com


Questions

Questions


Results

Results

  • Answers collected, analyzed - 11/09

  • Aggregate

  • Level of training

    • Junior – PGY 1, 2

    • Senior – PGY > 2

  • Statistical analysis – openepi.com

    • P value < 0.05, statistically significant


Results responses

Results - Responses

965 – 13.1 % of U.S. General Surgery Residents

961 completed entire survey (99.6%)

Junior Residents – 441 Senior Residents – 520


Results number times survey taken

Results Number Times Survey Taken


Results instruction on survey

Results Instruction on Survey


Results survey interpretation

Results – Survey Interpretation


Results effect on program

Results Effect on Program


Results honesty accuracy

ResultsHonesty/Accuracy


Conclusions

Conclusions

  • Evaluation mechanism in which

    • 52% do not understand questions

    • 14% did not answer truthfully

    • 37% do not feel is accurate

  • Not best tool to evaluate work hours compliance in residency programs

  • Consequences significant

  • Open letter to GME community 10/28/09

    • www.acgme.org

Nasca, T. www.ACGME.org


Thank you

Thank you !!

Program Directors

Residents


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